Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Important health care reform notice Women s preventive services covered with no member cost share www.aetna.com 00.03.689.1 E (10/15)
Good news for women Your health benefits and insurance plan covers the women s preventive services* listed here with no copays, coinsurance or deductible when you go to a provider in the network. * Employers with grandfathered plans may choose not to cover some of these preventive services, or to include cost share (deductible, copay or coinsurance) for preventive care services. Certain religious employers and organizations may choose not to cover contraceptive services as part of the group health coverage. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). Each insurer has sole financial responsibility for its own products.
You won t have to pay anything for these services when: The doctor or other health care provider is in our network, and the main purpose of your visit is to get preventive care Your doctor prescribes a female over-the-counter or generic contraceptive** that is approved by the U.S. Food and Drug Administration (FDA), and you fill it at a network pharmacy You buy a breast pump according to the guidelines of your plan But these services are not preventive when they are not billed as preventive by your doctor, or when the main reason for your visit is to diagnose, monitor or treat an illness or injury. Then copays, coinsurance and deductibles apply. We cover the following under our medical plans, whether or not you have pharmacy coverage with Aetna. There will be no member cost share when the main purpose of your service is preventive, or when the service is separately billed by your doctor as preventive. Certain contraceptive injectables and devices and their administration, such as the insertion of an intrauterine device (IUD) or injections, when billed by a participating doctor Women s sterilization procedures If the prescription benefit is: Here s how you get contraceptives without cost share: Contraceptive coverage The Aetna pharmacy plan covers women s contraceptive methods with no member cost share when prescriptions are filled at an in-network pharmacy. The Aetna medical plan covers two visits a year for patient education and counseling on contraceptives. We cover contraceptives with no member cost share when they are: Approved by the FDA Generic contraceptives on the Aetna preferred drug list, also called a formulary Over-the-counter female contraceptives when filled with a prescription Filled at an in-network pharmacy You can see the complete list of covered contraceptives online. 1. Visit www.aetna.com/formulary. 2. Choose your pharmacy plan type from the list on the bottom right of the page. 3. Scroll down to see various drug lists, including the Women s Contraceptive Drugs and Devices List. Covered by an Aetna pharmacy plan Covered by a different insurance company s pharmacy plan Not covered under a pharmacy plan Present your ID card to the pharmacist when purchasing female over-the-counter or generic contraceptive drugs and devices. Check directly with the prescription drug insurance company to learn how they cover contraceptive drugs and devices. Aetna medical plans will cover generic contraceptives with a prescription. You should pay for generic contraceptive drugs and devices at the pharmacy. Then send a completed claims form and the pharmacy receipt (which includes the patient s name, date of purchase, drug name and codes, and the charge) to us for reimbursement. ** Brand-name contraceptive drugs, methods or devices only covered with no member cost sharing under certain limited circumstances when required by your doctor.
Prenatal care and breastfeeding You have no member cost sharing (copays, coinsurance or deductibles) for preventive prenatal visits provided by an in-network provider. Normal cost sharing applies for delivery, postpartum care, ultrasounds or other maternity procedures, specialist visits and certain lab tests. Even if the plan doesn t cover maternity care, it will cover the preventive prenatal visits. Women who need support with breastfeeding can get up to six visits with a lactation consultant at no cost. In-network obstetrician/gynecologists (Ob/Gyns) and pediatricians may offer these services. You can also check our provider directory. Just log in to your secure member website at www.aetna.com or call the Member Services number on your Aetna ID card to find a lactation consultant in our network. We also cover: Certain standard electric breast pumps (nonhospital grade) anytime during pregnancy, after delivery or for as long as you breastfeed, once every three years Certain manual breast pumps anytime during pregnancy, after delivery or for as long as you breastfeed Another set of breast pump supplies, if you get pregnant again before you are eligible for a new pump Before buying a pump, check out the details on our website. Go to www.aetna.com and search for breast pumps. Or call Member Services to learn details of what is covered and find a participating breast pump supplier. Well-woman care Well-woman care includes counseling about important health issues, as well as: Screenings for: BRCA (counseling and genetic testing for women at high risk with no personal history of breast and/or ovarian cancer) Breast cancer chemoprevention (for women at higher risk) Breast cancer (mammography every 1 to 2 years for women over 40) Cervical cancer (for sexually active women) Chlamydia infection (for younger women and other women at higher risk) Gonorrhea (for all women at higher risk) Interpersonal or domestic violence Osteoporosis (for women over age 60 depending on risk factors) Alcohol misuse, obesity and tobacco use Blood pressure Cholesterol (for adults of certain ages or at higher risk) Colorectal cancer (for adults over 50) Depression Type 2 diabetes (for adults with high blood pressure) Human immunodeficiency virus (HIV) Syphilis Diabetes (including screening during pregnancy) Lung cancer (for adults ages 55 and older with a history of smoking), effective January 1, 2015 Immunizations Doses, recommended ages and recommended populations vary. Diphtheria, pertussis, tetanus (DPT) Hepatitis A and B Herpes zoster Human papillomavirus (HPV) Influenza Measles, mumps, rubella (MMR) Meningococcal (meningitis) Pneumococcal (pneumonia) Varicella (chickenpox) Medicine and supplements Aspirin up to 81 mg for women up to the age of 45 at risk for preeclampsia and up to 325 mg for women age 45 Folic acid supplements (for women of child-bearing ages) Vitamin D supplements for adults ages 65 and older with certain conditions Tobacco-cessation medicine, approved by the FDA, including over-the-counter medicine when prescribed by a health care provider and filled at a participating pharmacy Risk-reducing medicine, such as tamoxifen and raloxifene, for women ages 35 and older at increased risk for breast cancer, effective October 1, 2014 Additional services for pregnant women Anemia screenings Bacteriuria urinary tract or other infection screenings Rh incompatibility screening, with follow-up testing for women at higher risk Hepatitis B counseling (at the first prenatal visit) Expanded counseling on tobacco use Breastfeeding interventions to support and promote breastfeeding after delivery 5
Exclusions and limitations This plan does not cover all health care expenses and includes exclusions and limitations. Members should refer to their plan documents to determine which health care services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on the plan design or rider(s) purchased. All medical and hospital services not specifically covered in, or which are limited or excluded by, your plan documents, including costs of services before coverage begins and after coverage terminates Cosmetic surgery Custodial care Dental care and dental X-rays Donor egg retrieval Durable medical equipment Experimental and investigational procedures (except for coverage for medically necessary routine patient care costs for members participating in a cancer clinical trial) Hearing aids Home births Immunizations for travel or work Implantable drugs and certain injectable drugs including injectable infertility drugs Infertility services including, but not limited to, artificial insemination and advanced reproductive technologies such as in vitro fertilization (IVF), zygote intrafallopian transfer (ZIFT), gamete intrafallopian transfer (GIFT), intracytoplasmic sperm injection (ICSI), and other related services unless specifically listed as covered in your plan documents Nonmedically necessary services or supplies Orthotics, except diabetic orthotics Outpatient prescription drugs (except for treatment of diabetes), unless covered by a prescription plan rider, and over-the-counter medicine (except as provided in a hospital) and supplies Radial keratotomy or related procedures Reversal of sterilization Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies or counseling Special-duty nursing Therapy or rehabilitation other than what is listed as covered in the plan documents Weight-control services including surgical procedures, medical treatments, weight-control/loss programs, dietary regimens and supplements, appetite suppressants and other medicine, food or food supplements, exercise programs, exercise or other equipment, and other services and supplies that are primarily intended to control weight or treat obesity, including morbid obesity, or for the purpose of weight reduction, regardless of the existence of comorbid conditions
This information is subject to change as regulations are issued and interpretation evolves. This information should not be considered legal guidance regarding the ACA or its potential impact. Consult your legal or regulatory adviser for guidance. The content described in this communication is not intended to be legal or tax advice and should not be construed as such. The intent is to provide information only. We encourage you to consult with your legal counsel and tax experts for legal and tax advice. This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Rates and benefits may vary by location. Health benefits plans contain exclusions and limitations. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Plan features and availability may vary by location and group size. Providers are independent contractors and not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features are subject to change. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna s Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com. www.aetna.com 2015 Aetna Inc. 00.03.689.1 E (10/15)